目的:探讨支气管肺动脉成形术治疗中心型肺癌的效果。方法:1998年12月至2008年12月对16例中央型肺癌施行支气管肺动脉联合成形肺叶切除,包括双袖式左肺上叶切除7例;双袖式右肺上叶切除2例;双袖式右肺中上叶切除2例;双袖式右肺中上叶切除同时隆突重建2例;袖式左上肺叶切除、肺动脉楔形切除2例;袖式右肺中上叶切除、肺动脉楔形切除1例。结果:本组无死亡及吻合口瘘发生,术后2例出现肺不张,2例并发肺感染,全组术后1年生存率为93.8%,3年生存率为62.5%。结论:肺动脉成形或肺动脉支气管同时成形肺叶切除减少了全肺切除和单纯剖胸探查的比例,扩大了手术适应征,符合最大限度地切除肿瘤及最大限度保留肺功能的肺癌手术基本原则,是一种安全、有效、可行的术式。
ObjectiveTo explore the feasibility of robotic sleeve lobectomy and bronchoplasty and to summarize the experience of quality control and technical process management.MethodsFrom January to December 2018, our hospital completed robotic sleeve lobectomy and bronchoplasty for 5 patients, including the upper right lung lobe in 2 patients, the middle right lung lobe in 1 patient and the lower left lung lobe in 2 patients. There were 3 males and 2 females with an age of 56.6 (39-75) years. The surgical approach was the same as the surgical incision of the robotic lobectomy. During the operation, the lobes were separated, all enlarged mediastinal lymph nodes were cleaned, pulmonary hilum was dissected, pulmonary arteriovenous vessels and bronchi were exposed, and pulmonary vessels were treated. After exposing the main bronchi, the bronchi were cut off at the distal end of the lesion, and the lobes where the lesion was located (including lesions) were excised by sleeve type and the bronchi were continuously sutured with 3-0 Prolene from the back wall for anastomosis. After the anastomosis, no air leakage was found in the expanded lung, and the anastomosis was no longer wrapped.ResultsThe operation time was 147.4 (100-192) min, including bronchial anastomosis time 17.6 (14-25) min. Intraoperative blood loss was 60.0 (20-100) mL, and 20 (9-37) lymph nodes were dissected. Three patients had squamous cell carcinoma, 1 adenocarcinoma, and 1 neuroendocrine tumor. All patients showed negative results in the freezing pathology of bronchial stump during operation. All patients recovered well after surgery, without perioperative complications, and the anastomosis was smooth. Postoperative hospital stay was 10.8 (7-14) days. The patients were followed up for 6 to 12 months without anastomotic stenosis or other complications.ConclusionSince the robot system is a special instrument with 3D vision and 7 degrees of freedom for movable joints, the robotic bronchial suture is more flexible and accurate. The robotic sleeve lobectomy and bronchoplasty are safe and feasible.